Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.
Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China.
Biomed Res Int. 2019 Apr 18;2019:3692093. doi: 10.1155/2019/3692093. eCollection 2019.
Clinicopathologic and prognostic significance of body mass index (BMI) in breast cancer (BC) patients remained conflicting. We aimed to investigate and modify the impact of BMI on clinicopathological significance and survival in western Chinese BC patients.
8,394 female BC patients from Western China Clinical Cooperation Group (WCCCG) between 2005 and 2015 were identified. Multivariable logistic regression and Cox proportion hazard regressions were used to examine the difference of clinicopathologic and survival characteristics between BMI categories.
For the premenopausal, overweight and obese (OW) patients tended to have large tumor size (>5cm) (odds ratio [OR], 1.30, P<0.01) and triple-negative BC (OR, 1.31; P=0.01) compared with normal weight (NW) patients. Premenopausal underweight (UW) patients had a significantly higher risk of HER2 positive (OR, 1.71; P=0.02) and distant metastasis (OR, 2.59; P=0.01). For postmenopausal patients, OW patients showed higher risks of large tumor size (>5cm) (OR, 1.46; P=0.01), nuclear grade III (OR, 1.24; P=0.04), and lymphovascular invasion (OR, 1.46; P=0.01) compared with NW patients. An "U" shaped relationship between BMI and DFS was found (UW versus NW, adjusted hazard ratio (HR), 2.80, P<0.001; OW versus NW, adjusted HR, 1.40, P=0.02), whereas no significant difference of disease-free survival (DFS) between OW and NW premenopausal patients (adjusted HR=1.34, P=0.18) was revealed.
We concluded that UW and OW were associated with aggressively clinicopathological characteristics, regardless of menopausal status. An "U" shaped association of BMI and DFS was revealed, and no significant difference of DFS between OW and NW in postmenopausal subgroup was revealed.
体质量指数（BMI）在乳腺癌（BC）患者中的临床病理和预后意义仍存在争议。本研究旨在探讨并修正 BMI 对中国西部 BC 患者临床病理特征和生存的影响。
2005 年至 2015 年期间，从中国西部协作组（WCCCG）中确定了 8394 名女性 BC 患者。采用多变量逻辑回归和 Cox 比例风险回归分析 BMI 类别之间的临床病理和生存特征差异。
对于绝经前患者，超重和肥胖（OW）患者的肿瘤较大（>5cm）（比值比[OR]，1.30，P<0.01）和三阴性 BC（OR，1.31；P=0.01）的风险高于正常体重（NW）患者。绝经前消瘦（UW）患者的 HER2 阳性（OR，1.71；P=0.02）和远处转移（OR，2.59；P=0.01）的风险显著增加。对于绝经后患者，OW 患者的肿瘤较大（>5cm）（OR，1.46；P=0.01）、核分级 III 级（OR，1.24；P=0.04）和脉管侵犯（OR，1.46；P=0.01）的风险高于 NW 患者。BMI 与 DFS 之间呈“U”型关系（UW 与 NW，调整后的危险比[HR]，2.80，P<0.001；OW 与 NW，调整后的 HR，1.40，P=0.02），但绝经前 OW 和 NW 患者的无病生存率（DFS）无显著差异（调整后的 HR=1.34，P=0.18）。
我们得出结论，无论绝经状态如何，UW 和 OW 均与侵袭性临床病理特征相关。BMI 与 DFS 呈“U”型关系，绝经后亚组中 OW 和 NW 之间的 DFS 无显著差异。
